Treatment outcomes and factors associated with non-cure of tuberculosis in Wakiso district

Abstract

Background: Tuberculosis (TB) threatens public health all over the world. Uganda has not achieved the international targets for cure rate, treatment completion and default rate. Wakiso district in central part of the country has the highest TB burden, however the cure rates of tuberculosis in this district are quite low, below the national average of 80%. Objectives: To assess treatment outcomes of patients diagnosed with pulmonary TB for the period between January 2016 and December 2017, to determine factors associated with non-cure of TB among patients initiated on anti TB drugs in Wakiso district and to identify barriers to successful TB treatment in Wakiso district. Methods: This study employed mixed methods design; a retrospective cohort study to assess TB treatment outcomes, a nested case-control design to determine factors associated with non-cure having been initiated on TB treatment and a qualitative study to assess barriers to successful TB treatment. Information on treatment outcome was extracted from patient records in the health unit TB register while patients who cured of TB after treatment were compared to those who never cured after treatment. Pretested structured data extraction forms were used to obtain information from the TB register by trained research assistants. In-depth and key informant interviews were conducted to collect data from health workers and TB patients on perceived barriers to successful treatment of TB. The baseline characteristics were descriptively summarized using percentages and median while patient characteristics were compared using the chi-square test. Logistic regression analysis was used to identify risk factors for non-cure after being started on TB treatment. Results: Of the 576 patients records analyzed during the study period, 168 (29.2%) had completed treatment, 280 (48.6%) had cured, 40 (6.9%) died, 84 (14.6%) were lost to follow up while 4 (0.7%) were treatment failures. This implies that 296 (51.4%) did not have cure as treatment outcome. In multivariate analysis being clinically diagnosed with tuberculosis (OR; 8.81, 95%CI; 5.31-14.62), treatment interruptions (OR; 16.29, 95%CI: 8.29-32.03), Smoking (OR; 3.40, 95%CI; 2.01-5.77), and having treatment side effects (OR; 2.35, 95% CI; 1.09-5.09) were independent factors associated with non-cure of TB. Stigma, health service delivery related factors, social and economic factors, lack of adequate counseling and information related to TB treatment were identified as barriers to successful TB treatment. Conclusion: Interruption of treatment, smoking, type of TB and treatment side effects are predictors of non-cure in patients on TB medication while lack of knowledge, loss of income, stigma and lack of social support emerged as major barriers to successful TB treatment. Generally, to reduce poor treatment outcomes, there’s need to enhance patients counselling and education, introduce smoking cessation programs to TB patients, intensify strict follow up of TB patients by health workers or trained community health workers, development of more tolerable medication and improve management of side effects at health units. .